Over 13 % of Americans suffer from some form of chronic sinusitis. It is one of the most common medical complaints costing 6 billion dollars and 13 million doctor visits a year. While many sinus infections are self-limiting (will go away by themselves) or are easily treated with antibiotics, there is a group of patients for which sinus infections are a way of life. And one of the previously hidden causes for such sinus infections is now coming to light offering new hope to those who thought there was no answer.
Studies done by the Ferguson group of otolaryngologists at the University of Pittsburgh Medical Center initially looked at 5 patients whose treatment of sinusitis through endoscopic sinus surgery had failed. The elusive cause—a dental infection. What was interesting is that three of the five patients had already been screened for dental infections are were told that they had no dental pathology. The difference was a CT Scan, because the CT scan can see pathology that might otherwise be missed with conventional dental tests and x-rays. These patients were then retreated with extraction of the offending tooth or teeth along with sinus surgery. All five patients’ sinus symptoms resolved.
The group then looked at a sample of 186 patients who had previously had CT scans taken for sinusitis of the upper jaw. The findings were clear that many of the infections were of dental origin. What was even more significant was that the more fluid that was in the sinus and the more serious the sinus disease, the more likely it was due to an infected tooth. How significant? 86% of the acute severe sinus cases showed a dental origin.
The message is a telling one. First, the CT scan is much more diagnostic for a tooth-sinus relationship than was previously thought, and we need to look at that possibility more carefully. Second, we cannot always rely on conventional dental testing to diagnose a possible dental source of a sinus infection.
From a personal perspective, I have seen much more evidence of sinus pathology related to teeth since the advent of the dental cone-beam CT scan (CBCT).
If you have a sinus infection that hasn’t resolved, these findings could be significant for you. The action that I would take would be the following: Talk to your ENT surgeon. If your CT scan was taken recently, ask that a new review of the scan be done, looking for a possible dental source for your infection. If that is still unclear, get a dental CT scan taken and have it reviewed both by the dentist as well as a dental radiologist. If a dental infection is the source of the problem, a cooperative dental/medical approach may help you.
Lee N. Sheldon, DMD